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HomeMy WebLinkAbout0033 OCEAN STREET - HAZMAT �� % , � 3 33 Ocean St., Hyam i —SEACOAST i I a e � ° B a i TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: Mail To: BUSINESS LOCATION: Board of Health Town of Barnstable MAILING ADDRESS: a -An r P.O. Box 534 TELEPHONE NUMBER: 7L 3 e,,Ik Hyannis, MA 02601 CONTACT PERSON: 72� ` EMERGENCY CONTACT TELEPHONE NUMBER. L03 °/O g7 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities =11it any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) g� qS Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers ' o�n Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners n Asphalt & roofing tar Leather dyes of gQ&ir Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) �Tlift Paint & lacquer thinners PCB's FOA Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business °p IKE rok, Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 7 BARMASS. ,� 200 Main Street• Hyannis, MA 02601 t639. M a,0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT lE0 P'� Business Name: 17§0 n Date: �I Location/Mailing Address: Contact Name/Phone: Inventory Total Amount: � MSDS: License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: AMA Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodentcides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: Inspector Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS t►Ero Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BAR.S% E. ' 200 Main Street• Hyannis, MA 02601 059. �ArFDMP�a`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Seac o�g-� K v� Date: 7 /6 Location/Mailin 5� t4 yav -A i Contact Name/ o f 6- p Inventory Total Amount: SDS: �o o�4 ��- License#: Tier II : 0 Labeling: ©K Spill Plan: Oil/WaterSeparator: Floor Drains: ►V o Emergency Numbers: Storage Areas/Tanks: 1 t w�a� 3 Emergency/Containment i ment: Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers 5k t Hydraulic fluid (including brake fluid) 4 Wic�ld wash —4-0 t Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil � - Disinfectants h2 Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: 2 Caulk/Grout +j insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Ib }�i¢*k Other chlorinated hydrocarbons 1 k�o Laundry soil &stain removers (including carbon tetrachloride) (including bleach) ( Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: K. of 5 k &V �Ma 's "4spector: etp ! ��`SPvS�-` . �v ��LttiS.� � v�re Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS i